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Julia A. Haller’s Remarks at Jefferson University’s White Coat Ceremony

Jefferson White Coat Ceremony Remarks 7-26-19
Julia A. Haller, MD
Ophthalmologist-in-Chief
Wills Eye Hospital

Welcome to historic Jefferson, welcome to historic Philadelphia!

Speaking of history and Philadelphia, who here has heard of or seen the Broadway show Hamilton?

Great, because you are going to be studying in Hamilton’s Philadelphia footsteps, and believe it or not, there is a lot in Hamilton that applies to you!

Let me explain by focusing on two of the great songs written by Lin-Manuel Miranda who created and starred in Hamilton.

The first is called “The Room Where It Happens”.

This is what it’s about: In the show and in history, immigrant outsider Alexander Hamilton’s talent and ambitious drive have put him in an inner circle that contains some of America’s aristocracy, for example in the verse I’m about to recite, the landed gentry from colonial Virginia, Thomas Jefferson and James Madison. They are totally opposed to him. He wants to take control of the banks and taxes of the new country. Eventually of course he went on to head our Treasury Department, and founded our whole national financial system. Jefferson and Madison don’t want him to do that. But they do want the country’s capital to be in Virginia, not Philadelphia or New York. The song raps out the story about this and many other secret negotiations, and where they are held – The Room Where It Happens:
(And this is with apologies to Lin-Manuel Miranda, because I can’t even capture a faint echo of the genius of his accent and freestyle rap!)

Decisions are happening over dinner
Two Virginians and an immigrant walk into a room
Diametric’ly opposed, foes
They emerge with a compromise, having opened doors that were
Previously closed.
Bros
The immigrant emerges with unprecedented financial power
A system he can shape however he wants
The Virginians emerge with the nation’s capital
And here’s the piece de resistance
No one else was in
The room where it happened
The room where it happened
The room where it happened

No one else was in
The room where it happened
The room where it happened
The room where it happened

No one really knows how the game is played
The art of the trade
How the sausage gets made
We just assume that it happens
But no one else is in
The room where it happens

The room where it happens. Hamilton worked so hard to get there. And so have you. You are launching your ship on a vast new ocean. And it is such an exciting trip ahead of you - I know because I’ve been on it for quite a while. You will have a chance to literally be in the Room Where It Happens. The room where a pregnant mother first sees the ultrasound of her baby’s heart beating. The room where the baby is born! But also the room where a son learns that his father’s cancer has recurred. And the room where a family mourns the loss of someone very dear.

For me some of THE MOST EXCITING moments have involved research, and finding new cures. For example back at Hopkins in the 1990s before you were born, being one of the first two researchers to inject in a human eye a new drug that could literally stop blinding diseases like macular degeneration and diabetic retinopathy in their tracks. And here in Philadelphia just a few years ago while you were in high school, in the first successful trial of gene therapy ever, operating on children blind from inherited retinal disease, and injecting under their retinas the corrective genetic instructions, encoded in messenger RNA, linked to a vector that could penetrate into the nucleus of their cells, to give them back their sight. For me, and for those kids, that operating room, was The Room Where It Happened!

Equally satisfying has been the tremendous privilege of getting to know patients and being entrusted with their care. Last week I had the privilege of seeing a 17 year old soccer player, born with a birth defect in her left optic nerve that left her with no central vision and a detached retina, come back after surgery with her retina reattached, and have her ask me if I’d write her a college letter of recommendation. I said yes! Right after that I had a 90 year old lady with macular degeneration come in with her amazing and supportive family, and all these years after being in the room where it happened that a new drug was proven effective in our experimental clinical trial, I could save her vision by injecting that same drug, now commercially available. That was a full circle Room Where It Happened!

Years ago Dr. Francis Moore, the legendary Boston surgeon and chief at the Brigham Hospital there, wrote a memoir of his phenomenal life at a revolutionary time in medicine, beginning before penicillin became available. Moore went on to become the father of organ transplantation and burn care, and train a generation of worldwide surgical leaders, among many achievements. He remembers being just out of medical school and having a young boy acutely ill with appendicitis come into the emergency room. He wrote:
At some point in the spring of 1940 fully scrubbed and suitably attired I stood a few paces back from an operating table on which lay a naked boy of about 10, anesthetized. I can remember thinking how remarkable it was that institutions in our society could set things up so all the pieces would fall in place and I less than a year out of medical school and only 26 years of age might have the immense privilege of relieving the pain and anguish and threat to a wonderful small boy by making an incision in the right lower quadrant of his abdomen and taking out a pus-filled appendix skillfully and safely.... I felt that this was both a miracle and a privilege. I still do.

You are embarking upon the greatest career in the world, a career that will give you that phenomenal miraculous privilege. Make sure that you relish all of it, especially the hard parts. Seek out all the rooms where it happens. Be in them.

In Hamilton, Secretary Burr says to him: You got more than you gave.
Hamilton rejoins:
And I wanted what I got
When you got skin in the game you stay in the game
But you don’t get a win unless you play in the game

God help and forgive me
I wanna build something that’s gonna
Outlive me

I wanna be in the room where it happens
The room where it happens

Oh I’ve got to be in
The room where it happens
I’ve gotta be I’ve gotta be
In the room.

I conclude with a last analogy between the great Class of 2023 and Alexander Hamilton, based on another blockbuster song called “My Shot”.

Remember that Hamilton is an illegitimate, orphaned Caribbean refugee. He wants to win a scholarship to Columbia, then known as King’s College. He was smart and hard-working and fired by ambition. You have those qualities in common with him. And he knew that, in this great new land of opportunity, he had a shot at success - at making an impact. Just like you do. He is determined not to throw away that shot. He says:

I'm not throwing away my shot
I'ma get a scholarship to King's College
I prob'ly shouldn't brag, but dag, I amaze and astonish
The problem is I got a lot of brains but no polish
I gotta holler just to be heard
With every word, I drop knowledge
I'm a diamond in the rough, a shiny piece of coal
Tryin' to reach my goal my power of speech, unimpeachable
Only nineteen but my mind is older
These New York City streets get colder, I shoulder
Every burden, every disadvantage
I have learned to manage, I don't have a gun to brandish
I walk these streets famished
The plan is to fan this spark into a flame

And I am not throwing away my shot
I am not throwing away my shot
Hey yo, I'm just like my country
I'm young, scrappy and hungry
And I'm not throwing away my shot…
It’s time to take a shot.

You are young. Be scrappy and hungry. You have chosen a career that will put you in the room where it happens. You will see many miracles, and you will make miracles possible. You will have the incalculable privilege of being entrusted by your fellow human beings with their care. Seize every opportunity. Relish the hard moments more than the easy ones, because they will forge your steel. Good luck, class of 2023, it’s time to take your shot.